How Community Participation In Water And Sanitation Interventions Impacts Human Health, Wash Infrastructure And Service Longevity In Low-Income And Middle-Income Countries: A Realist Review
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Abstract: This realist review analyzes 73 WASH-related interventions across 29 countries, including Kenya, to assess how community participation shapes service outcomes. It maps five core mechanisms?accountability, diffusion, ownership, shame, and market dynamics?and 19 contextual triggers like leadership, trust, committee activity, and training. Evidence shows that inclusive participation leads to better hygiene adoption, infrastructure longevity, and reduced system collapse. The review categorizes these outcomes by socio-cultural, economic, and political settings. In Kenya, localized governance?through CBO-led water schemes and health education?correlates with improved equity and reduced dropout of services. However, participation is often superficial, constrained by donor timelines and weak support systems. The authors emphasize the need to define participation clearly, invest in feedback loops, and design interventions that foster sustained behavioral change. The review recommends embedding participatory design into climate adaptation for WASH systems, making it central to resilience planning and long-term health security.